The Case Against the Case Against Circumcision

Why one mother heard all of the opposing arguments, then circumcised her sons anyway.

Anyone with a heart would agree that the Jewish bris is a barbaric event. Grown-ups sit chatting politely, wiping the cream cheese off their lips, while some religious guy with minimal medical training prepares to slice up a newborn’s penis. The helpless thing wakes up from a womb-slumber howling with pain. I felt near hysterical at both of my sons’ brisses. Pumped up with new-mother hormones, I dug my nails into my palms to keep from clawing the rabbi. For a few days afterward, I cursed my God and everyone else for creating the bloody mess in the diaper. But then the penis healed and assumed its familiar heart shape and I promptly forgot about the whole trauma. Apparently some people never do.

I am Jewish enough that I never considered not circumcising my sons. I did not search the web or call a panel of doctors to fact-check the health benefits, as a growing number of wary Americans now do. Despite my momentary panic, the words “genital mutilation” did not enter my head. But now that I have done my homework, I’m sure I would do it again—even if I were not Jewish, didn’t believe in ritual, and judged only by cold, secular science.

Every year, it seems, a new study confirms that the foreskin is pretty much like the appendix or the wisdom tooth—it is an evolutionary footnote that serves no purpose other than to incubate infections. There’s no single overwhelming health reason to remove it, but there are a lot of smaller health reasons that add up. It’s not critical that any individual boy get circumcised. For the growing number of people who feel hysterical at the thought, just don’t do it. But don’t ruin it for the rest of us. It’s perfectly clear that on a grand public-health level, the more boys who get circumcised, the better it is for everyone.

Twenty years ago, this would have been a boring, obvious thing to say, like feed your baby rice cereal before bananas, or don’t smoke while pregnant. These days, in certain newly enlightened circles on the East and West Coasts, it puts you in league with Josef Mengele. Late this summer, when the New York Times reported that the U.S. Centers for Disease Control might consider promoting routine circumcision as a tool in the fight against AIDS, the vicious comments that ensued included references to mass genocide.

There’s no use arguing with the anti-circ activists, who only got through the headline of this story before hunting down my e-mail and offering to pay for me to be genitally mutilated. But for those in the nervous middle, here is my best case for why you should do it. Biologists think the foreskin plays a critical role in the womb, protecting the penis as it is growing during the third month of gestation. Outside the womb, the best guess is that it once kept the penis safe from, say, low-hanging thorny branches. Nowadays, we have pants for that.

Circumcision dates back some 6,000 years and was mostly associated with religious rituals, especially for Jews and Muslims. In the nineteenth century, moralists concocted some unfortunate theories about the connection between the foreskin and masturbation and other such degenerate impulses. The genuinely useful medical rationales came later. During the World War II campaign in North Africa, tens of thousands of American GIs fell short on their hygiene routines. Many of them came down with a host of painful and annoying infections, such as phimosis, where the foreskin gets too tight to retract over the glans. Doctors already knew about the connection to sexually transmitted diseases and began recommending routine circumcision.

In the late eighties, researchers began to suspect a relationship between circumcision and transmission of HIV, the virus that causes AIDS. One researcher wondered why certain Kenyan men who see prostitutes get infected and others don’t. The answer, it turned out, was that the ones who don’t were circumcised. Three separate trials in Uganda, Kenya, and South Africa involving over 10,000 men turned up the same finding again and again. Circumcision, it turns out, could reduce the risk of HIV transmission by at least 60 percent, which, in Africa, adds up to 3 million lives saved over the next twenty years. The governments of Uganda and Kenya recently started mass-circumcision campaigns.

These studies are not entirely relevant to the U.S. They apply only to female-to-male transmission, which is relatively rare here. But the results are so dramatic that people who work in AIDS prevention can’t ignore them. Daniel Halperin, an AIDS expert at the Harvard School of Public Health, has compared various countries, and the patterns are obvious. In a study of 28 nations, he found that low circumcision rates (fewer than 20 percent) match up with high HIV rates, and vice versa. Similar patterns are turning up in the U.S. as well. A team of researchers from the CDC and Johns Hopkins analyzed records of over 26,000 heterosexual African-American men who showed up at a Baltimore clinic for HIV testing and denied any drug use or homosexual contact. Among those with known HIV exposure, the ones who did turn out to be HIV-positive were twice as likely to be uncircumcised. There’s no causal relationship here; foreskin does not cause HIV transmission. But researchers guess that foreskins are more susceptible to sores, and also have a high concentration of certain immune cells that are the main portals for HIV infection.